Substantial epidemiological evidence indicates that alcohol consumed in moderation is associated with a lower risk of myocardial infarction (MI). Similar but less extensive evidence suggests that alcohol consumption is associated with better prognosis following MI, but this association has been tested virtually entirely among men. Even as the number of women with established coronary heart disease (CHD) continues to grow, almost no information is available to determine the possible risks and benefits of alcohol intake in this clinically vulnerable population. Exploration of the association between alcohol intake and prognosis among women with CHD is clearly needed. Men and women differ greatly in their drinking habits and beverage choices, metabolism of ethanol, susceptibility to many effects of alcohol, and their prognosis following MI, sharply limiting the generalizability of previous studies on men. In this application, we propose to explore the association of alcohol intake with long- term mortality among women enrolled in two complementary inception cohorts of adults hospitalized with CHD. These include the Determinants of Myocardial Infarction Onset Study, a multicenter cohort of patients hospitalized with confirmed acute MI at medical centers across the US, and the Swedish Mammography Cohort post-MI subgroup, a population-based cohort of women with a history of MI in central Sweden. In addition, we will describe the drinking patterns of U.S. women at higher cardiovascular risk, and their change over time, using the Behavioral Risk Factor Surveillance System, a population-based yearly telephone survey. Our primary hypothesis is: 1. Alcohol use up to 1 drink per day is inversely associated with total and cardiovascular mortality among women who survive hospitalization for both acute coronary syndromes and MI. Secondary exploratory aims include: 1. The association between alcohol consumption and total mortality is similar across alcoholic beverage types. 2. To describe the prevalence of alcohol use and heavy episodic drinking among women with coronary heart disease or cardiovascular risk factors. 3. To describe recent trends in alcohol use among women with coronary heart disease. PUBLIC HEALTH RELEVANCE: The number of women living with coronary heart disease is increasing, but almost no information is available to evaluate the possible risks and benefits of drinking alcohol in this vulnerable population. In this study we will evaluate the impact of drinking alcohol on the long-term prognosis of women who have survived heart attacks. We will also evaluate current trends in drinking behavior among women in the US who have coronary heart disease or are at high risk of developing it.